Question re pain medications - before & after surgery

Hi folks - hope everyone's doing ok today!

I have a general question......I'm just starting my journey toward having surgery -- went to orientation meeting and now waiting for call re appt. with weight loss center.  I've done a lot of research. etc.

I am currently on a pretty high dosage of narcotic pain medication - have been on it for about two years -- tried all sorts of other meds with no success.  With this med, the pain is tolerable.  My pcp called last week - he's not aware yet that I've started the WLS track - but he did recommend it several times before.  Out of the blue, he wants me to go to a clinic and get weaned off the meds -- I do not want to stop the med because it'sthe only thing that has helped.  I have chronic pain in neck, back, knees, hips etc.  Tried p/t, injections, all types of other meds.

Will WL surgeon need me to get off meds prior to surgery?  I don't have any bad side effects from the meds such as respiratory issues, etc.  If pcp insists, I was thinking of changing doctors.  I took a lot of time to work up to getting this med at this dosage - but like I said, it gives me relief. I said to my doctor if it's not broke, why fix it.  But I'm wondering what WL surgeon would say about it.

Also, after surgey, should I expect pain relief in general?  I think if I went for testing today, doctors would say I need hip and knee replacements  and rotator cuff surgery!  Like I said, I have real pain issues!  

Thanks for any imput you can give me. 

Mary























 

If you have pain enough to ever need NSAIDS, do NOT get a RNY. Narcotics are a different beast...but if any of your meds at all are NSAIDS, consider either a VSG or a DS.

Liz

I would be interested to know if you can find a surgeon who will work with you and let you remain on narcotics.  But if you ever expect to need to use NSAIDs you should NOT get an RnY. 

Let us know what you find out.

~Becky

I had pretty severe pain, could hardly walk, due to arthritis in my left hip,  since my sleeve surgery i no longer need pain meds.  losing the weight has been the answer to my prayers,  but i was never on narcotics,  they make me nauseous and i'd rather be in pain than feel the need to upchuck.   I hope all goes well for you on your journey.  The reason i won my appeal for the sleeve was my belief i would always need nsaids,  and you cannot take them with the bypass,    happy to say i no longer need them.  :o) jeani

Jeani,

Congrats on not needing any nsaids at this point but at least, one day if you need them again, you will be able to take them. Just remember to take a PPI with them as well.

Liz

Thanks sweetie,  i have taken them once or twice since surgery (headache), and thanks to all the great folks here on OH i do know to take them with a ppi.  :o) jeani

It sounds like weight loss may actually help you with the pain of your knees and hips. And if you have to have replacements then it should make your recovery easier too.

I think you need to let your PCP know you are considering the WLS and have him speak to your surgeon and have them come up with a plan. If you don't mind sharing.....what exactly are you taking now for pain relief and how much?

You did not say what and how long and what med you were taking. I find it surprising that the prescribing MD would suddenly have cold feet regarding your medication unless there was an early renewal or something to alert him. But putting all things in perspective pain is an issue that needs to be addressed and if you have achieved a medically supervised pain control plan of care with acceptable results he should just leave well enough alone. One problem could be that you need to move into a higher catigory of narcotic which he is not comfortable in prescribing. There is a max dose to all the narcotics when a doctor should consider the next step-up.  The usual progression is NSAID, to Hydrocodone, to Oxycodone, to Oxycotin, to Dilauded (rarely used in home due to it's propensity to supress respirations, and abuse), and MS Cotin (morphine sulfate in long acting pill form). I do not know about how we do with the cotins because I do know they reach peak level with-in 30 min of taking them.
With all this in mind, losing weight will decrease some of the weight bearing joint pain such as hip, knee and feet. Also, if you have heavy arms it might improve your shoulder pain by having better range of motion.
I have been taking hydrocodone for about 5 years. At the time of surgery I was taking 10mg four times a day for pain in my feet and knees. Now, two years and 100 pounds lighter I am taking 2 tylenol 3x/day in addition to 5 mg of hyrdrocodone 1-3x/day depending on how active I am. I have developed pain in my back and shoulders since surgery. Like they say: if it's not one thing it is another. But taking narcotics is not a problem with surgery many people out there take them.

PCPs are under ever increasing scrutiny regarding Schedule 2 (Opioid) prescriptions, particularly those of an on-going nature.  Likely, your PCP brought this up because 1) s/he got a notice / form letter from the DEA about increased scrutiny; 2) Another patient was discovered doing something illegal; or 3) Some other event, unrelated to you, that caused him/her to raise the issue with you.

To appease the powers that be and to reduce their exposure, PCPs are increasingly referring Chronic Pain patients to Doctors that specialize in the treatment of Chronic Pain.  Pain Clinics are all about coping with pain rather than the cause of the pain.  They do all those things necessary to keep their practices within the law while providing you with pain relief.

Before choosing a Pain Clinic do some research.  Some are very anti-narcotics which is problematic if your best treatment is narcotics.  Some focus on P/T, Chiro, and other treatments.  Once you have the right pain Doctor, things may go a bit differently than with your PCP.  You will have monthly visits to review your pain levels and to get Rx refills.  Periodically, you will be given Urine Drug Tests to ensure you are taking the meds prescribed (and not selling them) and that you are not taking drugs you have not been prescribed.  They also get some sort of printout from somewhere showing what Schedule 2 Rx's you've filled (to ensure you're not getting drugs elsewhere).  As long as you are honest and consistent you should get all the pain relief you need.

WLS + Narcotics

Narcotics should not be an issue for WLS, unless your surgeon is Anti-Drugs for some personal reason.  If you run up against any Doc that rules out any treatment for personal beliefs, run.  Just be sure to discuss your medications with your surgeon (and keep reminding him/her, as they have hundreds of patients, and won't necessarily remember your unique issues).

Time Released medications may (or may NOT, YMMV) be an issue Post-Op.  If you take Oxycontin or MS-Contin (Contin = time released), you may (or may NOT) need to change.  Oddly, for me Oxycontin didn't work (passed right through), while MS-Contin works fine.

I had RNY, but have no issues with NSAIDs, nor are they as great a risk as many want you to believe.  I have liver issues, and many (formerly) MO/SMO patients have undiagnosed liver issues, so for me Tylenol is to be avoided.

Discuss your situation honestly and openly with your medical team.  Fortunately, as you lose weight you may find your chronic pain issues are reduced.

Good Luck.

One thing I can think of is this - pain meds can very often cause pain. Over time they can, and do cause MORE pain ...sounds counterintuitive but it's true.

I had to go inpatient to get weaned off my meds years ago and while I was in there I was on a special "pain track" instead of regular "rehab"... I learned a ton of things about my chronic pain and man oh man is life different today. My pain actually went DOWN once I got off of everything. I take nothing for pain today narcotics-wise unless I have surgery.

I haven't had to go back on narcotics since I finished rehab...turns out the counselors were right, the pills were causing the pain and I was pissed off about it at first but I got over it. I'm an addict and tried to defend my right to chemical peace of mind...couldn't stand the pain. Once everything was out of my system things actually got better.

I'd go for it, you have nothing to lose and everything to gain. At the VERY least it would be a medication vacation and you could start over at a lower dose if you NEEDED to.

Peace
Binda